Medical College of Georgia at Augusta University Augusta, GA
John Erikson L. Yap, MD1, Jacqueline T. Chan, MD2, Pearl Princess Uy, MD2; 1Medical College of Georgia at Augusta University, Augusta, GA; 2Medical College of Georgia, Augusta, GA
Introduction: Hypertriglyceridemia (HTG) is an uncommon but well-established etiology of acute pancreatitis (AP). The risk and severity of AP increases with higher triglycerides ( >1000 mg/dL). HTG is not an obligatory component of diabetes (DM) but are often found together more so in uncontrolled DM. Ketogenic diet (Keto-diet) has grown popularity for both weight loss and alternative diet for DM but if not done properly can by itself contribute to the worsening of HTG. We present a case of well-controlled DM patient who developed severe necrotizing HTGP after a trial of keto-diet.
Methods: A 19-year-old obese male with well controlled type 2 DM (HbA1c of 5.6%) self-initiated keto-diet in hope of losing weight and cutting back on insulin. He denied alcohol use. He was admitted in the ICU for severe AP after presenting with abdominal pain and vomiting. His labs showed lipase of 2,195 U/L hyperglycemia of 319 mg/dL without acidosis as well as HTG of 6,021 mg/dl. He was managed with IV fluids, insulin drip, fibrates, statin and eventually requiring apheresis. He decompensated and developed persistent fever, required intubation, IV antibiotics, and pressor support. Cultures came back negative. Imaging showed necrotic parenchyma in the pancreatic body with large ascites concerning for pancreatic ascites and no gallstones. A paracentesis confirmed diagnosis with amylase levels of 25,389 U/L. An Endoscopic Retrograde Cholangiopancreatogram was performed and a pancreatic duct (PD) stent was successfully deployed to bridge the disrupted PD. He was discharged after a prolong 8 weeks of admission.
Discussion: Keto-diet is a diet consisting of high fat, low carbohydrate and adequate protein. The aim is to have the body use fat for energy instead of carbohydrates. Due to the nature of the diet, this puts patients at risk of having dyslipidemia such as HTG. Although this diet may be beneficial to control blood sugar level, care must be taken to assure healthy dietary fat intake which involves a dietician especially in patients at risk for AP. HTG induced pancreatitis (HTGP) is often associated with a higher severity and complication than other etiology of AP. Lipid lowering medication, insulin, heparin and apheresis have been used to rapidly lower the HTG to treat HTGP. To our knowledge, we only found one case involving a pediatric non-DM 9-year-old girl who died of HTGP attributed to keto-diet. Our case would be the first adult case reported to have HTG-induced pancreatitis due to keto-diet.
Disclosures: John Erikson Yap indicated no relevant financial relationships. Jacqueline Chan indicated no relevant financial relationships. Pearl Princess Uy indicated no relevant financial relationships.